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15080100CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19409 STEVENS CREEK BLVD CONTRACTOR: PERMIT N0; 15080100, OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR ` DATE ISSUED: 10/16/2015 OWNER'S PHONE: 6503441500g� � " I L I PHONE Nj6gJD jig IFfs r LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL PEPPERDATA STE 260 (MAIN STREET) - T.I. TO BUILD License Class Lie. # ) T SHELL FOR (N) B OCCUPANCY (6,404 S.F.((FLEX Y Contracto A Date ` r I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: Sq. Ft Floor Area: Valuation: $239000 I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the erformance of the work for which this permit is issued. APN Number: 31620112.19409 Occupancy Type: I have and will maintain Worker's Compensation Insurance, as provided' for by Section 3700 of the Labor Code, for the performance of the work for which this Permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is WITHIN 180 DAYS OF PERMIT ISSUANCE OR correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives this 180 DAYS FROM LAST CALLED INSPECTION. of city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino liabilities, a C r YLtu ' against judgments, costs, and experts h may accrue against said City in consequence of the Issued by: Date: granting of it dditi ly, the applicant understands and will comply with all non -poi rce a ' er the Cuperti unicipal Code; Section 9.18. �p Signature Date �G RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ® ER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm hat I am exempt from the Contractor's License Law for one of the following , o reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as ownerthe property, or my employees with wages as their sole compensat an, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) HAZARDOUS MATERIALS DISCLOSURE 2. 1, as owner of the property, am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project (Sec.7044, Business & Professions Code). California Health & Safety Code, Sections 25505, 25533, and 25534. 1: will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty of perjury one of the following three declarations: Safety Code, Section 25532(x) should I store or handle hazardous material.. 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Additionally, should I use equipment or devices which emit hazardous air Compensation, as provided for by Section 3700 of the Labor Code, for the contaminants as defined by the Bay Area Air Quality Management District I will performance of the work for which this permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 2. 1 have and will maintain Worker's Compensation Insurance„ as provided for by Health Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this � Own o authofized agent: permit is issued. Date: o 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker'sCONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I I hereby irm that there is a construction lending agency for the performance of work's construction must forthwith comply with such provisions or this permit shall be deemed for which this permit issued (Sec. Civ C.) Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter I understand my plans shall be used as public records. upon the above mentioned property for inspection purposes. (We) agree to save Licensed Professional indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION' 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingna.cupertino.org CiPE6TlP© I NEW CONSTRUCTION ❑ ADDITION I AI AT.TRRATT(1N / TT F-1 PMff-ZrnXT i nvr; I Vt)6, �nrl —TAT „ _ .. PROJECT ADDRESS. �. ,y„ - f /fYV1 APN# 9t��1/2+ ` O ER //1! l NMEAM B 0 PHOIt/,-c; �. E AA,, (.• 6. � ST T D RES CITY, -TATE ZIP � � FAX b t 6 2 PHONE C M1116'10010C) S g �) jUf ST ET DRE CITY TE IP FA� 780 0105 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ARCHITECT 11 ENGINEER ❑ DEVELOPER ❑. TENANT CONTRALTO A E LICENSE NUMB R LICENSE T BUS. LIC # COMPANY LI E_ L 1141 -f1 STREET ADC SS AeC fzk CI ,STT ZIP + !�?'�r Q,j� �/j? Yj /iJ �✓e�0 ARCHITECT/EN LICENSE NUMBER BUS. LIC # . COMPANY NAME 'nry G {,.,V• E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORKC&"' dA �tr° - 6 4 6 FL EXIST SE PROPOSED USE - CONSTRTYPE #STORIES - - - d., t USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR - DEMO TOTAL - - - - AREA. AREA. AREA -.KITCHEN NET AREA ��., ®. 8 f BATHROOM - OTHER - REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA. TOTAL DECK/PORCH AREA GARAGE AREA: F1 DETACH I ❑ ATTACH DWELLING UNTTs: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES - �� BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # lga^ PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? RECE BY: O VALUATION: By my signature below, I certify toeo the following: I am the property owner or authorized agent to act on the property owner's behalf I have read this application and the information I hav pro ided i ect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t build representatives of Cupertino to enter the above -identified property for inspection purposes. Mrize Signature Applicant/Agent; of Date: SUPPLEMENT)ff- RqF011MATION REQUIRED Q PLAN CHECK, TS PE _-. ' , ;,,. _ ROUTING SLIP, = OVER-THE-COU1tTTER BUILDING PLAN.REViE94' — New SFD or Multifamily dw lings: Apply for demolition permit for existing building(s). Demolition p rmi s required prior to issuance of building permit for new building. EXPRESS PIAIlNINGPLANREVZE44 _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD. PlullLIe WORXS r `_ r4 form if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior toTA t - s T SANIMY submittal of Building Permit application. ❑ ,> NVHfONI4n N1 TMALTH BldgApp 2011.doc revised 06/21/11 um CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 19409 S.C.13 Suit 260 DATE: 08112/2015 REVIEWED BY: Sean XPN: *VALUATION: 1$239,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRICommercial Building MARY Comial BPENTAMATION USE: FiFPPERMIT TYPE: 113TI WORK [Tenant Improvement for Pepperdata in suite 260 (6404 sg ft). - SCOPE I OCCUPANCY TYPE: TYPE OF CONSTR.— FLR, AREA Lsx) PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) 11-8,111-B,1V,V-B 6,404 $2,513.10 1BT1PLN--C–K $5,259.75 IBTIINSP PME Plan Check: $0.00 Permit Fee: $5,259.75 Suppl. Insp. Fee: •_} Reg. 0 OTF —oo I hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 6,404 $2,513.10 $5,259.75 _01, � - yis, A,Iech.,P! in Check I I - tc I Phtnib. Plan Clieck E'Iee. Plaii Check Al,lec,h Perm" hee: 1 1: 1 1 1,erinit fele: U . I Alfflnb. Permit T'ee: Other_Ue,h. hmp, I I I I Orher.Pland')Jmp. - I I I I othel'Alec, hls/,'�. 'rhno Fee.. up, 1�_ee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Puhlic Works, Fire, Sanitary Sewer District, School District. etc.). Thine ft-pv aro havad nn ilea nrafimi"ary i"fnrm"fin" ­­;Mh1a -4 — —A, ih. 7)..i F- —M.11 ­1�, FEE ITEMS (Fee Resolution 7.1-053 Eff. ZjdJ3 FEE -7 QTY/FEE MISC ITEMS Plan Check Fee: $2,513.10 Select a Mise Bldg/Structure or Element of a Building Su 1. PC Fee:, (E) Reg. 0 OT T 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $5,259.75 Suppl. Insp. Fee: •_} Reg. 0 OTF —oo I hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 A1(b1'1h-7hV1P'U1h`e Fee.* 0 (D Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 Strong Motion Fee: IBSEISMICO $66.92 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $10.00 S $7,849.771 $0.00 T $ 7,849.77 Revised: 07/02/2015 Building Department City Of Cupertino 10300 Torre Avenue ,Cupertino, CA 95014-3255 T&lephone: 408-777-3228 Fax! 408-777-3333 JO.B ADDRESS: 19409 Stevens Creek Blvd. #260 PERMIT P, 15080100 OWNER'S NAME: main Street Cupertino Aggregator Pf IONE # (650) 948-6930 GENERAL CONTRACTOR. CartmelIrrarn Construction, Inc. BUSINESS LICENSE # 36752 ADDRESS:4001 Page Mill Road C1TY/-ZlPQ0D.E; Los Altos Hills, 94022 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDINGFINAL OR FINAL OCCUPANCY INSPECTION(S) WILL Bk SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPEKr1NO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable.subcontract.ors and complete the following.information: V SUBCONTRAC'rOR BUSINESS NAME, BUSINESS LICENSE # Cabinets & Millwork Bayside Commercial Casework, Inc Cement Finishing Electrical TDN Electric, Inc. 28386 Excavation Fencing Flooring / Carpeting Commercial Design Services Linoleum /'Wood Glass / Glazing Crediford Enterprises Heating The Trillo Companies, Inc. 29816 Insulation South Bay Interiors, Inc. 25499 .............. Landscaping Lathing Masonry Painting / Wallpaper Joel Favela Painting 55 Paving Plastering Plumbing Fresno Plumbing & Heating, Inc. 32000 Roofing . ........ Statewide Roofing 23509 Septic Tank . .... Sheet Metal Sheet Rock South Bay Interiors 25499 Tile . -... - z- 41 �- JNL Marble & Granite .- . . ......... . ... 552jD-l' 71-/- � -11n b/O I 'Date //5